Should women take antidepressants during pregnancy?

Depression is a common disorder in the US and a number of women take antidepressants before becoming pregnant and others develop depression during pregnancy. A common class of antidepressants are selective serotonin reuptake inhibitors (SSRIs; examples are Lexapro, Prozac, and Paxil). Some recent studies have reported that SSRIs can be harmful to the mother and/or developing fetus when taken during pregnancy; however, a new study reports that SSRIs can improve language development in offspring. The findings were published on October 8 in the Proceedings of the National Academy of Sciences by researchers affiliated with researchers at the University of British Columbia (UBC), Harvard University, and the Child & Family Research Institute (CFRI) at BC Children’s Hospital.

The researchers reported that treatment with SSRIs can accelerate babies’ ability to attune to the sounds and sights of their native language, while untreated maternal depression can prolong the period of tuning. “This study is among the first to show how maternal depression and its treatment can change the timing of language development in babies,” noted Prof. Janet Werker of UBC’s Dept. of Psychology, the study’s senior author. “At this point, we do not know if accelerating or delaying these milestones in development has lasting consequences on later language acquisition, or if alternate developmental pathways exist. We aim to explore these and other important questions in future studies.”

The study followed three groups of mothers: one being treated for depression with SSRIs, one with depression not taking antidepressants, and one with no symptoms of depression. By measuring changes in heart rate and eye movement to sounds and video images of native and non-native languages, the researchers calculated the language development of babies at three intervals, including six and 10 months of age. Researchers also studied how the heart rates of unborn babies responded to languages at the age of 36 weeks in the uterus.

“The findings highlight the importance of environmental factors on infant development and put us in a better position to support not only optimal language development in children but also maternal well-being,” noted Werker, who adds that treatment of maternal depression is crucial. “We also hope to explore more classes of antidepressants to determine if they have similar or different impacts on early childhood development.”

The current study suggests that this key developmental period, which typically ends between the ages of eight and nine months, can be accelerated or delayed, in some cases by several months. In another recent study, Werker has found that this development period lasts longer for babies in bilingual households than in monolingual babies, particularly for the face recognition aspects of speech.

A study by Canadian researchers published online on March 22, 2012 in the British Journal of Clinical Pharmacology, evaluated the risk of developing pregnancy-induced hypertension (PIH) among women who took antidepressants. The researchers theorized that, because antidepressants had an effect on blood vessels, they might increase the incidence of PIH.

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The researchers reviewed data from the Quebec Pregnancy Registry and linked provincial medical, pharmaceutical, hospital, and birth databases. They identified 1,216 women with a diagnosis of PIH) with or without pre-eclampsia (toxemia) and with no history of hypertension before pregnancy. They randomly selected 10 controls for each case, matched for date of diagnosis and gestational age. The results were adjusted for socio-demographic characteristics, maternal depression, anxiety, other chronic conditions, medication use, and health service utilization.

The investigators found that among the 1,216 women, 45 (3.7%) had used antidepressants during pregnancy compared with 300 (2.5%). After adjusting for potential confounders (data-distorting factors), the use of antidepressants during pregnancy was significantly associated with increased risk of PIH. In addition, use of selective serotonin reuptake inhibitors (SSRIs), and more specifically, paroxetine (Paxil) were associated with an increased risk of PIH.

The author concluded that women who use antidepressants during pregnancy are at increased risk of PIH with or without preeclampsia above and beyond the risk that could be attributed to their depression or anxiety disorders.

Another study published online in the British Medical Journal (BMJ) on January 12, 2012 found that SSRIs are linked to pulmonary hypertension in newborns of mothers who took them during pregnancy. The study was published by researchers at the Karolinska Institutet in Stockholm, Sweden; it found that pregnant women who take SSRIs may be exposing their infants to the risk of risk of developing persistent pulmonary hypertension, which is a life-threatening condition that occurs in up to 2 per 1000 live-born infants. The researchers reported that that infants born to women treated with SSRIs in late pregnancy had a two-fold increased risk for persistent pulmonary hypertension compared with infants born to women who did not use SSRIs.

Lead author Dr. Kieler noted, “The absolute risk was three infants per 1,000 exposed, and the increased risk seemed to be a class effect of SSRIs, as risks for the specific SSRIs––sertraline (Zoloft), citalopram (Celexa, Ciprami), paroxetine (Paxil), and fluoxetine (Prozac)––were of similar magnitude." Dr. Kieler added that an earlier study, published in 2006 in the New England Journal of Medicine by Christina D. Chambers, MD, and colleagues, reported a six-fold increased risk; however, that study did not address specific substances because the study sample was limited, with too few infants exposed to the antidepressants.

Take home message:
These studies report both benefits and risks of taking SSRIs. All things considered, these medications should be avoided if at all possible. Hypertension and pulmonary hypertension can be life-threatening or fatal; however, impaired language development can usually be successfully treated with speech therapy. Any woman taking, or considering taking, antidepressants should discuss her individual situation with a healthcare professional. Alternatives to medication should be discussed. This can benefit both you and your unborn child. If alternatives to medication successfully treat the depression, the risk of language impairment would be decreased.